Apixaban, compared with warfarin, was associated with a decreased risk of stroke/systemic embolism (HR 0.70; 95% CI 0.51-0.96) and major bleeding in Medicare patients with CKD and AF.
Cohort (n=22,739)
Do direct-acting oral anticoagulants reduce stroke/systemic embolism, major bleeding, or death compared to warfarin in Medicare patients with atrial fibrillation and chronic kidney disease?
In Medicare patients with atrial fibrillation and chronic kidney disease, apixaban was associated with lower risks of stroke/systemic embolism and major bleeding compared to warfarin, whereas rivaroxaban and dabigatran showed no significant differences.
Hazard Ratio: 0.7 (95% CI 0.51–0.96)
BACKGROUND AND PURPOSE: The comparative effectiveness of direct-acting oral anticoagulants, compared with warfarin, for risks of stroke/systemic embolism, major bleeding, or death have not been studied in Medicare beneficiaries with atrial fibrillation and nondialysis-dependent chronic kidney disease. METHODS: Medicare data from 2011 to 2017 were used to identify patients with stages 3, 4, or 5 chronic kidney disease and new atrial fibrillation who received a new prescription for warfarin, apixaban, rivaroxaban, or dabigatran. We estimated marginal hazard ratios with 95% CIs for the association of each direct-acting oral anticoagulant, compared with warfarin, for the outcomes of interest using inverse-probability-of-treatment weighted Cox proportional hazards models in as-treated and intention-to-treat analyses. RESULTS: A total of 22 739 individuals met criteria (46.3% warfarin, 29.6% apixaban, 17.2% rivaroxaban, 6.9% dabigatran). Across the groups of anticoagulant users, mean age was 78.4 to 79.0 years; 50.3% to 51.4% were women, and 80.3% to 82.8% had stage 3 chronic kidney disease. In the as-treated analysis, for stroke/systemic embolism, hazard ratios, all compared with warfarin, were 0.70 (0.51-0.96) for apixaban, 0.80 (0.54-1.17) for rivaroxaban, and 1.15 (0.69-1.94) for dabigatran. For major bleeding, analogous hazard ratios were 0.47 (0.37-0.59) for apixaban, 1.05 (0.85-1.30) for rivaroxaban, and 0.95 (0.70-1.31) for dabigatran. There was no difference in the risk of all-cause mortality between the direct-acting oral anticoagulants and warfarin. Results of the intention-to-treat analysis were similar. CONCLUSIONS: Apixaban, compared with warfarin, was associated with decreased risk of stroke/systemic embolism and major bleeding; risks for both outcomes with rivaroxaban and dabigatran did not differ from risks with warfarin.
Wetmore et al. (Thu,) conducted a cohort in chronic kidney disease and atrial fibrillation (n=22,739). Direct-acting oral anticoagulants (apixaban, rivaroxaban, dabigatran) vs. Warfarin was evaluated on stroke/systemic embolism (HR 0.70, 95% CI 0.51-0.96). Apixaban, compared with warfarin, was associated with a decreased risk of stroke/systemic embolism (HR 0.70; 95% CI 0.51-0.96) and major bleeding in Medicare patients with CKD and AF.